身痛逐瘀汤加减治疗瘀血阻滞型腰背肌筋膜疼痛综合征的临床观察

Clinical Observation of Addition and Subtraction Therapy of Shentong Zhuyutang to Myofascial Pain Syndrome( MPS) with Stagnation of Blood Stasis

目的:观察身痛逐瘀汤加减治疗瘀血阻滞型腰背肌筋膜疼痛综合征的近期和远期疗效及作用机制。方法:将148例的符合要求的患者采用随机按数字表法分为对照组73例和观察组75例。两组患者均给予电针治疗。对照组口服腰痛胶囊,4粒/次,3次/d。观察组内服身痛逐瘀汤加减,1剂/d。两组均连续治疗6周,并进行16周的随访。于治疗前、治疗后1,2,3,4,5和6周进行评价疼痛视觉模拟评分(VAS),评价治疗前后日本骨科协会下腰痛评价量表(JOA),Roland-Morris功能障碍问卷表(RDQ),身体损害指数评定量表(PⅡ量表)、瘀血阻滞证评分和匹兹堡睡眠质量指数(PSQI);检测治疗前后血液流变学指标,检测治疗前后血栓素2(TXB_2),6-酮-前列腺素F_(1α)(6-keto-PGF_(1α)),并计算TXB_2/6-keto-PGF_(1α)(T/K),随访并记录复发情况。结果:经秩和检验,观察组临床疗效优于对照组(Z=1.969,P<0.01);经重复测量的方差分析,两组患者在治疗后1,2,3,4,5和6周VAS评分均逐渐降低(F_(对照)=5.801,F_(观察)=6.649,P<0.05);经配对t检验,观察组在治疗后第2,3,4,5和6周时VAS评分均低于对照组(P<0.01);观察组JOA量表三个维度评分和JOA总分均高于对照组(P<0.01);观察组患者RDQ,PⅡ,PSQI和瘀血阻滞证评分均低于对照组(P<0.01);观察组患者全血黏度(高切、低切),血浆黏度,纤维蛋白原水平均低于对照组(P<0.01);观察组患者TXB_2低于对照组,6-keto-PGF_(1α)高于对照组,T/K低于对照组(P<0.01);观察组复发率12%,低于对照组的26.03%(χ~2=4.745,P<0.05)。结论:在针刺治疗的基础上,采用身痛逐瘀汤加减内服治疗瘀血阻滞型腰背肌筋膜疼痛综合征患者近期可减轻疼痛,恢复腰部活动功能,远期可减少复发,具有改善血液循环、抗炎、镇痛作用。

Objective: To observethe short and long term effect of addition and subtractiontherapy of Shentong Zhuyutang to myofascial pain syndrome( MPS) withstagnation of bloodstasis and to investigate its mechanism of action. Method: One hundred and forty-eight eligible patients were randomly divided into control group( 73 cases) and observation group( 75 cases) by random number table. Patients in both groups got electroacupuncture treatment. Patients in control group additionally got Yaotong capsules,4 grains/time,3 times/day. Patients in observation group additionally got addition and subtractiontherapy of Shentong Zhuyutang,1 dose/day. The treatment was continued for 6 weeks in both groups,and 16 weeks follow-up was recorded. Before treatment,and atthe 1st,2nd,3rd,4th,5th,6th week after treatment,scores of visual analogue scale( VAS) was graded. Before and after treatment,scores of JOA,Roland-Morris disability questionnaire( RDQ),body damage index assessment scale( PⅡ scale),stagnation of bloodstasis,and Pittsburgh sleep quality index( PSQI) were graded. Levels ofthromboxane 2( TXB2),6-ketone-prostaglandin F1α( 6-keto-PGF1α) were detected,and TXB2/6-keto-PGF1α was calculated;in addition,the recurrence was recorded and followed up. Result: By rank sum test,the clinical efficacy in observation group was betterthanthat in control group( Z = 1. 969,P < 0. 01). Analysis of variance of repeated measures indicatedthat,scores of VAS were decreased gradually atthe 1st,2nd,3rd,4th,5th,6th week in both groups after treatment( Fcontrol= 5. 801,Fobservation= 6. 649,P < 0. 05). Paired t-test indicatedthat scores of VAS in observation group were lowerthanthose in control group at 2nd,3rd,4th,5th,6th week( P <0. 01). Scores ofthree dimensions of JOA scale and total score in observation group were higherthanthose in control group( P < 0. 01). Scores of RDQ,PⅡ,PSQI,stagnation of bloodstasis,whole blood viscosity( high cut and low cut),plasma viscosity,fibrinogen,TXB2,and T/K in observation group were lowerthanthose in control group( P < 0. 01),and level of 6-keto-PGF1αwas higherthanthat in control group( P < 0. 01). In addition,the recurrence rate in observation group was 12%,lowerthan 26. 03% in control group( χ2= 4. 745,P < 0. 05).Conclusion: Based on acupuncture treatment,addition and subtractiontherapy of Shentong Zhuyutang can relievethe pain caused by myofascial pain syndrome( MPS) withstagnation of bloodstasis,recover lumbar activity function,reduce rate of recurrence,and ameliorate blood circulation,with anti-inflammatory and analgesia effects.